# A 35-year-old pregnant client at 20 weeks gestation is admitted with acute pyelonephritis. Which nursing intervention should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542956  
> language: ko  
> subject: Adult Health

## 문제

A 35-year-old pregnant client at 20 weeks gestation is admitted with acute pyelonephritis. Which nursing intervention should be the priority?

## 보기

1. Encourage increased fluid intake to 3-4 liters per day
2. Apply heat to the affected flank area for comfort
3. Position the client in Trendelenburg position
4. Monitor for signs of preterm labor contractions **✔ 정답**

**정답: 4**

## 해설

Monitoring for preterm labor is the priority because pyelonephritis significantly increases this risk. Other interventions are important but not immediate priorities.

## 심화 해설

Clinical Judgment
This question assesses your understanding of prioritization and pregnancy complications. For a mother at 28 weeks of pregnancy with acute pyelonephritis, the most important nursing intervention is monitoring for signs of preterm labor. Pyelonephritis during pregnancy is a serious infection; the inflammatory response and bacterial toxins can trigger uterine contractions, significantly increasing the risk of preterm labor. Therefore, preventing and early detecting potentially life-threatening preterm labor is the top priority among all interventions.

Memory Tip
Remember **P**yelonephritis in **P**regnancy = **P**reterm labor **P**riority (the 3P rule). Pyelonephritis during pregnancy means preterm labor is the priority.

KR vs US
In Korea, while managing urinary tract infections during pregnancy, the risk of preterm labor is recognized. In the US NGN/CJMM, risk recognition and preventive monitoring are emphasized more systematically, training nurses to determine priorities by asking, "What is the most dangerous complication?"

## 임상 시나리오

Clinical Practice Guide
When caring for a patient with pyelonephritis during pregnancy, the following comprehensive approach is necessary.
1.  Preterm labor monitoring: Regularly assess uterine contractions (frequency, intensity, duration), changes in vaginal discharge, and pelvic pressure.
2.  Infection management: Administer prescribed antibiotics (generally cephalosporins) on time and evaluate their effectiveness.
3.  Hydration: Encourage IV fluid administration and oral fluid intake to prevent dehydration and maintain renal perfusion, but watch for overhydration.
4.  Pain management: Use pregnancy-safe analgesics (e.g., acetaminophen), and applying heat to the infected area is contraindicated.

Caution
In SATA (Select All That Apply) questions, although it may seem like "all interventions are important," the action that prevents the 'most dangerous' complication in the patient's current condition is always the top priority. "Increasing fluid intake" is a correct intervention, but it has a lower priority than preterm labor monitoring, which addresses an immediate life threat.

## 핵심 개념

- **Acute Pyelonephritis** — Acute pyelonephritis. Infection of the kidney and renal pelvis, mainly caused by bacteria (such as E. coli). During pregnancy, the risk of occurrence is high due to ureteral relaxation and urinary stasis.
- **Preterm Labor** — Preterm labor. A condition after 20 weeks and before 37 weeks of pregnancy characterized by regular uterine contractions and cervical changes. Pyelonephritis is one of the major triggering factors.
- **Trendelenburg Position** — Trendelenburg position. A position where the patient's head is lower than the torso and the legs are elevated. Generally contraindicated during pregnancy as it can cause inferior vena cava compression and respiratory difficulty.
- **Hydration** — Hydration. Important in pyelonephritis management to maintain renal perfusion and help flush out bacteria, but avoid overhydration and it is a lower priority than preterm labor monitoring.
- **Uterine Contraction** — Uterine contractions. A major sign of preterm labor. The nurse should assess the frequency, intensity, and duration to determine if preterm labor has started.

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